Individual
MRS. JACQUELINE SUSANN BROWN STICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
205 E 5TH AVE, RANSON, WV 25438-1613
(304) 728-1812
Mailing address
254 FITZGERALD ST, GERRARDSTOWN, WV 25420-1404
(540) 533-1965
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024176995
VA
363L00000X
Nurse Practitioner
Primary
APRN97879NP
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001131963
VA RN LICENSE
VA
01
—
0024176995
VA APRN LICENSE
VA
01
—
97879
WV RN LICENS
WV
01
—
APRN97879NP
WV APRN LICENSE
—
01
—
F11180017
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
—
Enumeration date
01/17/2019
Last updated
04/21/2022
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